Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms

Abstract

Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis. Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities. Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %–99.1%) and 99.4 % (98.5 %–99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %–83.8 %), 79.3 % (75.9 %–82.4 %), and 86.1 % (83.2 %–88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities (P < .05). NBIME showed a lower PPV for M-SM1 cancer (P < .05), as with WLE (P = .08) compared to A-NBIME. Fleiss’s kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 – 0.46), 0.52 (0.49 – 0.56) and 0.65 (0.62 – 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities. Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.

Diagnostic efficacy of the Japan Narrow-band-imaging Expert Team and Pit pattern classifications for colorectal lesions: A meta-analysis

“…A total of 1146 articles were initially searched (351 in Web of Science, 241 in PubMed, 44 in Cochrane Library, and 510 in Embase), and 31 studies[ 5 , 13 - 42 ] with a total of 14674 patients were ultimately included in this meta-analysis. 1114 studies were excluded of which 306 studies were duplicate references, 442 studies were excluded based on title and abstract, and 70 studies were excluded after full-text review.…”

“…The JNET classified colorectal lesions into four categories: Type 1 is a hyperplastic polyp (HP)/sessile serrated lesion (SSL), Type 2A is a LGD/adenoma, Type 2B is a HGD/M-SM-s and Type 3 is a SM-d[ 5 ]. The Pit pattern classification has five corresponding categories: Type I is normal mucosa, Type II is hyperplasia/SSL, Types III L /IV are LGD/adenomas, Types III S /V I-L, and V I-H /V N are associated with HGD/M-SM-s lesions, and SM-d lesions, respectively[ 13 ]. The detailed interpretation criteria are shown in Table 1 .…”

“…General information on the included studies is presented in Table 2 . Of the 31 studies[ 5 , 13 - 42 ], 11 were retrospective [ 5 , 13 - 22 ], and 20 were prospective[ 23 - 42 ]. Seven studies[ 14 - 20 ] used the JNET classification alone, 21 studies[ 22 - 42 ] used the Pit pattern classification alone, and only 3 studies[ 5 , 13 , 21 ] used both the JNET and Pit pattern classifications in the same population.…”

“…Of the 31 studies[ 5 , 13 - 42 ], 11 were retrospective [ 5 , 13 - 22 ], and 20 were prospective[ 23 - 42 ]. Seven studies[ 14 - 20 ] used the JNET classification alone, 21 studies[ 22 - 42 ] used the Pit pattern classification alone, and only 3 studies[ 5 , 13 , 21 ] used both the JNET and Pit pattern classifications in the same population. Thirteen studies[ 5 , 13 - 16 , 18 - 21 , 24 , 28 , 35 , 41 ] used narrow-band imaging magnifying endoscopy (NBI-ME), 13 studies used magnifying chromoendoscopy[ 22 , 25 - 27 , 29 , 30 , 32 - 35 , 37 , 38 , 42 ], and the other studies used BLI-magnification[ 17 , 23 ] ( n = 2), NBI[ 31 , 39 ] ( n = 2), and chromoendoscopy[ 36 , 40 ] ( n = 2).…”

“…Twenty-one studies[ 5 , 13 , 21 - 42 ] involving 6150 colorectal lesions reported the diagnostic value of the Pit pattern classification. The pooled values for each category were as follows.…”